Physician Wages Vary Widely Based on Specialty
By Guy Boulton
Dallas, TX | Posted May 2, 2016
The average pay for internists increased 12% last year nationally, according to a survey by Medscape, a website for physicians and others in health care.
The increase was the highest of any medical specialty and tied to that for rheumatology. The average compensation for internists now is $222,000, according to the online survey in which almost 19,200 physicians participated.
Internists and other physicians who provide primary care have long been in short supply, because most graduates of medical schools go into higher-paying specialties. However, more internists also are becoming “hospitalists,” who, as the name implies, focus on care for hospitalized patients.
“We are seeing the same thing as every other health care organization,” said Jeffrey Bahr, vice president of primary care for Milwaukee-based Aurora Health Care.
Internists do more of their training in hospitals than family practice physicians.
“To become a hospitalist is a pretty smooth transition,” Bahr said.
Wheaton Franciscan Healthcare also is seeing the same trend — and the resulting increase in competition has increased compensation for internists, Brandon Wilson, director of physician recruitment, said in an email.
The average compensation for internists still is well below the average compensation of all physicians — $302,000 a year in Wisconsin, based on the Medscape survey.
The survey also shows the wide range in what physicians make a year.
Their wages — or income if self-employed — range from a national average of $204,000 for pediatricians to $443,000 for orthopedic surgeons, according to Medscape survey. And within many specialties are subspecialties that pay considerably more.
Other surveys show a similar range, though the figures vary. However, the surveys make it clear that physicians who perform surgeries and procedures generally are paid far more than other physicians, particularly those in primary care.
The three highest-paid specialties are orthopedics, cardiology and dermatology, according to the Medscape survey. The three lowest-paid are pediatrics, endocrinology and family medicine. (Neurosurgery, the highest-paid medical specialty, was not included in the survey.)
Many health economists and policy analysts consider the long-standing gap to be one of the flaws in the American health care system.
You get what you pay for, and the U.S. health care system excels at intensive, high-tech medicine. However, the system performs poorly on many measures, such as managing the care of patients with chronic diseases, compared with other developed countries.
The difference in compensation for physicians who do procedures and those who don’t can even be seen within a specialty.
Each year, Merritt Hawkins, a unit of AMN Healthcare, a staffing company, releases a report on starting salaries and first-year signing bonuses for physicians it has been hired to recruit.
The average for a cardiologist who does invasive procedures, such as angioplasty, was $525,000 and as high as $650,000 last year. For a cardiologist who does not do procedures, the average was $291,000 and as low as $250,000.
“Cardiology to me is the simplest picture of the economics of health care today,” said Travis Singleton, a senior vice president for Merritt Hawkins.
“Our system favors procedures, and it puts diagnostics at a disadvantage,” he said. “That’s just the way we pay doctors. There’s no two ways around it, and there’s no better example than cardiology.”
The gap between primary care and the highest-paid specialties partially accounts for the small percentage of medical school graduates who go into primary care. And the Medscape survey found that physicians in family and internal medicine were the least likely to again choose their specialty.
“A lot of people enter primary care as a calling and not just a job,” said Bahr of Aurora.
But the reality of the job — from the administrative tasks to the hours — often proves disappointing.
The Medscape survey found that compensation increased 6% for family practice physicians. But that was in line with other specialties, such as urology and radiology.
It also was 6% of a much smaller base.
Family practice physicians and internists have been the most recruited physicians for nine consecutive years, according to Merritt Hawkins.
Katherine Nonweiler, a second-year resident in family medicine at Columbia St. Mary’s, already has been contacted by recruiters.
Nonweiler, who grew up in Oshkosh and plans to practice there, was drawn to family medicine by the variety and the chance to provide care for people of all ages.
However, some of her fellow students, she acknowledged, did ask why she wanted to go into the specialty, given the hours and lower pay.
By most standards, of course, all physicians make a good wage. But few people realize the sacrifices that go into becoming a physician.
“What people are doing in going to medical school is to put off their lives for seven to 12 years,” said William Hueston, senior associate dean for academic affairs at the Medical College of Wisconsin.
That’s after the work required to get into medical school — and it only gets harder from there.
The biggest shock for medical students is the volume of material they must learn and the pace at which they are expected to learn it, Hueston said. He estimates that workload is double what they faced as college students and requires 80 to 100 hours a week of study.
Four years of medical school is followed by three years of residency. And that is followed by fellowships that can last four years or longer for specialists.
The sacrifices typically mean a delay in starting a family and amassing large debts from tuition and living expenses. And though residents now make about $60,000 to $62,000 per year, they can work as much as 80 hours a week, and that’s in addition to studying for their boards.
All this means that the decade that is the most fun and carefree for many people — their twenties — is anything but for medical students and residents.
“That’s an accurate statement,” Hueston said.